Tag Archives: Centrelink

It seems to me that the government departments that deal with disability payments (from all different countries) have a policy to just reject all claims (like the insurance company in The Rainmaker).

I know that every time I have applied for anything from Centrelink (the Australian version), I have been rejected; and each time, I have either had to appeal or follow-up with many, many phone calls. But each time, I have received (finally!) what I was supposed to receive.

So, today’s post is going to try to make it easier for Aussie FM sufferers to get the Disability Support Pension. (If you are from another country and can write a post that will help others from your country, I am happy to publish it)

DISABILITY SUPPORT INFORMATION

*** Please note – This is NOT legal advice This has been written based on my personal experience: I successfully appealed the rejection of my Disability Support Pension application.

I have put this together, hoping it will help others in the same predicament.

Basically, this is how it works:

You apply for Disability Support Pension
You must have a total impairment rating of 20 points or more under the Impairment Tables.
To get a rating you must have a permanent condition that is more likely than not to persist for more than 2 years.
You receive Disability Support Pension

Seems easy, right?

When can a rating be assigned?

An impairment rating can only be assigned for permanent conditions which cause an impairment that is more likely than not to persist for more than 2 years.

A condition is permanent if:

the condition has been fully diagnosed by an appropriately qualified medical practitioner, and

In determining whether a condition has been fully diagnosed by an appropriately qualified medical practitioner and whether it has been fully treated, the following is to be considered:

whether there is corroborating evidence of the condition, and

what treatment or rehabilitation has occurred in relation to the condition, and

whether treatment is continuing or is planned in the next 2 years.

Fully stabilised

A condition is fully stabilised if:

either the person has undertaken reasonable treatment for the condition and any further reasonable treatment is unlikely to result in significant functional improvement to a level enabling the person to undertake work in the next 2 years, or

the person has not undertaken reasonable treatment for the condition and:

significant functional improvement to a level enabling the person to undertake work in the next 2 years is not expected to result, even if the person undertakes reasonable treatment, or

there is a medical or other compelling reason for the person not to undertake reasonable treatment.

This is the point where most of our applications are rejected.

I suggest that, when writing a letter of appeal (or even your first statement), you address each point clearly and concisely.

When you get past this point, you can move on to your impairment…

Assessment of Impairment Ratings

As part of the qualification for a Disability Support Pension (DSP), a person must have one or more physical, intellectual or psychiatric impairment(s) that attract a total impairment rating of 20 points or more under the Impairment Tables.

For the purposes of DSP, the Impairment Tables are tables designed to assess impairment in relation to work. The tables were revised earlier this year, so you need to make sure that you are looking at the right information. (The Centrelink representative will always ask you if you looked at the most recent tables!)

(9) There is no Table dealing specifically with pain and when assessing pain the following must be considered:

(a) acute pain is a symptom which may result in short-term loss of functional capacity in more than one area of the body; and

(b) chronic pain is a condition and, where it has been diagnosed, any resulting impairment should be assessed using the Table relevant to the area of function affected; and

(c) whether the condition causing pain has been fully diagnosed, fully treated and fully stabilised for the purposes of subsections 6(5) and (6).

The statements in BOLD are what is important to us. We can use ALL the tables to get a total of 20 as we have a number of conditions that cause our impairment!

Section 10(5) states:

(5) Where two or more conditions cause a common or combined impairment, a single rating should be assigned in relation to that common or combined impairment under a single Table.

(6) Where a common or combined impairment resulting from two or more conditions is assessed in accordance with subsection 10(5), it is inappropriate to assign a separate impairment rating for each condition as this would result in the same impairment being assessed more than once.

Now, I don’t expect you to read all the tables (although I did) but have a look at the headings for each:

Table 1 – Functions Requiring Physical Exertion & Stamina

Table 2 – Upper Limb Function

Table 3 – Lower Limb Function

Table 4 – Spinal Function

Table 5 – Mental Health Function

Table 6 – Functioning Related to Alcohol, Drug & Other Substance Use

Table 7 – Brain Function

Table 8 – Communication Function

Table 9 – Intellectual Function

Table 10 – Digestive & Reproductive Function

Table 11 – Hearing & Other Functions of the Ear

Table 12 – Visual Function

Table 13 – Continence Function

Table 14 – Functions of the Skin

Table 15 – Functions of Consciousness

This is where, in your letter/statement, you get personal. Address each and every one of these tables, if they affect you. Give examples. Explain how it affects your life. the more information that you give, the better.

Your Letter

Attach every piece of information that you have from any doctors (you can ask them for copies of correspondence to other doctors)

Like this:

It seems to me that the government departments that deal with disability payments (from all different countries) have a policy to just reject all claims (like the insurance company in The Rainmaker).

I know that every time I have applied for anything from Centrelink (the Australian version), I have been rejected; and each time, I have either had to appeal or follow-up with many, many phone calls. But each time, I have received (finally) what I was supposed to receive.

So, today’s post is going to try to make it easier for Aussie FM sufferers to get the Disability Support Pension. (If you are from another country and can write a post that will help others from your country, I am happy to publish it)

DISABILITY SUPPORT INFORMATION

*** Please note – I am a first year lawyer, therefore I have not had much experience with the Social Security Act 1991. However, I successfully appealed the rejection of my Disability Support Pension application.

I have put this together, hoping it will help others in the same predicament.

Basically, this is how it works:

You apply for Disability Support Pension
You must have a total impairment rating of 20 points or more under the Impairment Tables.
To get a rating you must have a permanent condition that is more likely than not to persist for more than 2 years.
You receive Disability Support Pension

Seems easy, right?

When can a rating be assigned?

An impairment rating can only be assigned for permanent conditions which cause an impairment that is more likely than not to persist for more than 2 years.

A condition is permanent if:

the condition has been fully diagnosed by an appropriately qualified medical practitioner, and

In determining whether a condition has been fully diagnosed by an appropriately qualified medical practitioner and whether it has been fully treated, the following is to be considered:

whether there is corroborating evidence of the condition, and

what treatment or rehabilitation has occurred in relation to the condition, and

whether treatment is continuing or is planned in the next 2 years.

Fully stabilised

A condition is fully stabilised if:

either the person has undertaken reasonable treatment for the condition and any further reasonable treatment is unlikely to result in significant functional improvement to a level enabling the person to undertake work in the next 2 years, or

the person has not undertaken reasonable treatment for the condition and:

significant functional improvement to a level enabling the person to undertake work in the next 2 years is not expected to result, even if the person undertakes reasonable treatment, or

there is a medical or other compelling reason for the person not to undertake reasonable treatment.

This is the point where most of our applications are rejected.

I suggest that, when writing a letter of appeal (or even your first statement), you address each point clearly and concisely.

When you get past this point, you can move on to your impairment…

Assessment of Impairment Ratings

As part of the qualification for a Disability Support Pension (DSP), a person must have one or more physical, intellectual or psychiatric impairment(s) that attract a total impairment rating of 20 points or more under the Impairment Tables.

For the purposes of DSP, the Impairment Tables are tables designed to assess impairment in relation to work. The tables were revised earlier this year, so you need to make sure that you are looking at the right information. (The Centrelink representative will always ask you if you looked at the most recent tables!)

(9) There is no Table dealing specifically with pain and when assessing pain the following must be considered:

(a) acute pain is a symptom which may result in short-term loss of functional capacity in more than one area of the body; and

(b) chronic pain is a condition and, where it has been diagnosed, any resulting impairment should be assessed using the Table relevant to the area of function affected; and

(c) whether the condition causing pain has been fully diagnosed, fully treated and fully stabilised for the purposes of subsections 6(5) and (6).

The statements in BOLD are what is important to us. We can use ALL the tables to get a total of 20 as we have a number of conditions that cause our impairment!

Section 10(5) states:

(5) Where two or more conditions cause a common or combined impairment, a single rating should be assigned in relation to that common or combined impairment under a single Table.

(6) Where a common or combined impairment resulting from two or more conditions is assessed in accordance with subsection 10(5), it is inappropriate to assign a separate impairment rating for each condition as this would result in the same impairment being assessed more than once.

Now, I don’t expect you to read all the tables (although I did) but have a look at the headings for each:

Table 1 – Functions Requiring Physical Exertion & Stamina

Table 2 – Upper Limb Function

Table 3 – Lower Limb Function

Table 4 – Spinal Function

Table 5 – Mental Health Function

Table 6 – Functioning Related to Alcohol, Drug & Other Substance Use

Table 7 – Brain Function

Table 8 – Communication Function

Table 9 – Intellectual Function

Table 10 – Digestive & Reproductive Function

Table 11 – Hearing & Other Functions of the Ear

Table 12 – Visual Function

Table 13 – Continence Function

Table 14 – Functions of the Skin

Table 15 – Functions of Consciousness

This is where, in your letter/statement, you get personal. Address each and every one of these tables, if they affect you. Give examples. Explain how it affects your life. the more information that you give, the better.

Your Letter

Attach every piece of information that you have from any doctors (you can ask them for copies of correspondence to other doctors)

My grandmother used to have orchids. Every year, they would bloom beautifully and be displayed on the dining room table. In 1983, she died. The orchids stopped blooming. I tried to split them up and re-pot them to encourage them to bloom. My Mommy, uncle and I all got a pot. They didn’t bloom.

Just before my uncle had his operation, my pot grew a stalk. It’s going to bloom! And the operation went well.

Prior to getting my biopsy results, Mommy’s pot grew a stalk. It’s going to bloom! And the results were fine.

Last night, my uncle told me his orchid had sprouted a stalk. Wow! I told him that it must mean our luck was changing and more good things were going to happen.

Well, I have a major headache and I’m feeling totally lethargic. BUT don’t feel sorry for me…I’m just coming down from a massive high (natural, of course!)

I had a doctor’s appointment today, basically for more Centrelink paperwork, (they are just totally unable to organise all the paperwork to be done in one session!) at 3.30pm and was just leaving the house at 3pm when the phone rang. Yes, I answered it. It was the Centrelink lady (remember the one from last week?) Oh, great – just what I wanted: another conversation about how my condition is not stabilised!

BUT guess what? (and you’ve probably guessed considering I started a new paragraph for it) I got my disability support pension (with backpay from January)! Oh my! Giant sigh of relief mixed with joy. Thank you! Thank you! Thank you! She did say that Centrelink will check up along the way, in case I get better (I wish!) but that’s it – it’s mine. Thank you!

So yes, I’ve been on cloud nine for a couple of hours, unable to wipe the smile from my face. We (Mommy, my Uncle and I) like to think that my grandmother is watching over us. Corny, yes? But ever so nice.

Because Mommy and I begged my third rheumatologist (her almost in tears, me with tears dripping down my face) to refer me to rehab (which is costing me a small fortune) and to experiment a little with my medication (I was started on Lyrica back in November and nobody wanted to try anything different before giving up on me and any improvement), my condition is not considered to be fully stabilised.

Supposedly, it doesn’t help that the doctor’s report (from the first rheumatologist) states that he believes that there will be significant improvement within 3 to 12 months (despite telling Mommy and I that there was nothing else he could do for me – how was this improvement supposed to come about, then?)

So, I’m up to my third rheumatologist who also thinks he cannot do anything for me, so Mommy and I decided we had to do it ourselves but we still need him (or my GP) for referrals and their prescription pads.

But it appears that for Centrelink to decide that my condition is fully stabilised, I need to give up. I need to remain on my current medication. I need to continue to feel my current pain. I need to lose my train of thought on a regular basis. I need to feel exhausted every day. I need to recoil from daylight. I need to shy away from bright lights at night (and during the day). I need to endure my restless nights. (You get the idea.)

But this is what it seems Centrelink requires from me. The lady told me it wasn’t quite over yet – but don’t get my hopes up.

Lucky me – after that fabulous conversation, I got to have a needle in my boobie (actually three)!

So this week, I’ve started a puppet theatre (the rest to be completed on Thursday), looked after the munchkin nephew and worked on my fairy garden so today I’m going to have a rest. No hydrotherapy – just rest…well sort of.

I must hand in my medical certificate to Centrelink, to let them know that yes! I still have fibromyalgia (thanks for asking – NOT!) And I will probably have to stand in line for over an hour to do this. I am actually permitted to post it in but I definitely do not trust Centrelink – they have lost my forms too many times for me to take the risk.

I also have to do that awful squishy-boobie thing: a mammogram. Really not looking forward to this; not only because of the squishy-boobie part but, because it seems that I have very lumpy boobs and so far, in my mammogram life, I have had to submit to a biopsy EVERY time. Luckily for me (knock on wood), nothing malignant has been discovered; so it’s off to radiology again. Remember, ladies, October is International Breast Cancer Awareness Month – don’t be putting off the necessary!

By self-managing fibromyalgia pain and controlling daily stress, many people with FM can do almost anything they choose, by making simple modifications to your workplace that allow you to continue working.

What Type of Workplace Changes Can Help Someone With Fibromyalgia?

First, openly discuss your condition with your boss. Talk about the symptoms of pain, fatigue, and stiffness. Explain how you may have good days and bad days.

Explaining will give people at work a better idea of what you are feeling each day. Ask your boss if you can take rest periods on bad days. Or ask if you can take work home if you are feeling fatigued. Ask if you can come in on Saturday if you miss a day of work to make up the lost time and income. In addition, ask if you can put a cot in your office for a brief nap at lunchtime. Taking a midday nap helps many people with fibromyalgia and other chronic health conditions function on the job.

Are There Workplace Modification Guidelines for People With Fibromyalgia?[i]

To address concentration issues, employers should consider:

providing written job instructions when possible

prioritizing job assignments and providing more structure

allowing flexible work hours and allowing a self-paced workload

allowing periodic rest periods to reorient

providing memory aids, such as schedulers or organizers

minimizing distractions

reducing job stress

To address depression and anxiety, employers should consider:

reducing distractions in the work environment

providing to-do lists and written instructions

reminding the employee of important deadlines and meetings

allowing time off for counseling

providing clear expectations of responsibilities and consequences

providing sensitivity training to coworkers

allowing breaks to use stress management techniques

developing strategies to deal with work problems before they arise

allowing telephone calls during work hours to doctors and others for support

To address issues associated with sleep disorders, employers should consider:

allowing flexible work hours and frequent breaks

allowing the employee to work from home

My employer has been very considerate and co-operative in regards to my condition. We have tried different combinations (eg: 3 hours x 3 days per week in the afternoons, working on the weekend when there are no distractions or noise, working late at night when I seem to be less distracted) however none of these have worked on a consistent basis. So far, I cannot see how I can maintain employment with FM.

If you have tried different jobs and are unable to work, you might consider applying for disability. It can be a long and arduous journey, dealing with our Human Services departments and disability may be difficult to get because of rules about work capacity.

The Americans with Disabilities Act has a general definition of disability that each person must meet. Therefore, some people with FM will have a disability under the ADA and others will not.

Because fibromyalgia is extremely hard to diagnose and there are no laboratory tests to prove the ailment to a third-party, it’s important that you do your homework before you apply for disability. And remember that you may be denied but, there are avenues to appeal decisions. Be aware of your rights! And check, and double-check, time limits!

How Do I Apply for Disability?

To apply for disability benefits, call your Social Security/Centrelink office. Much of the information may be provided over the phone, by mail, or the Internet. You will be asked specific questions about how you have trouble with daily activities. And you will need to be as specific as you can, describing your limitations and why you cannot work. You will be asked to give the names and addresses of your doctors. The Social Security office will contact each one for records.

What Other Proof Must I Provide for Disability?

Describing your fibromyalgia symptoms alone will not qualify you for Social Security disability. You have to be specific about signs and physical findings related to fibromyalgia and pain and how that impacts your ability to work. The Social Security staff will consider all your symptoms, including pain.

All of this information considered together must lead to a conclusion that you are disabled before you will be granted disability with benefits.

What if I’m not Approved for Disability?

It is common that fibromyalgia patients are not approved for disability, especially with the first application. If you are not approved, you’ll have the right to appeal. Some patients find it necessary to have the help of a lawyer during the appeal process. Although it may increase your costs, the chance your case will be approved is usually better if you have legal counsel.

I have applied (as some of you may know) and was rejected because it was decided that I do not have an impairment rating of 20 or more. As such, I have started the initial phase in the appeal process.

What Type of Documentation Is Needed to Get Disability?

It’s important to get detailed documentation – reports – from your doctors, including psychologists, at the onset of your illness. Have your doctors submit documentation of all prescribed medications, therapies, and lifestyle remedies necessary to resolve your fibromyalgia symptoms. You should also be evaluated by a fibromyalgia specialist, usually a rheumatologist. This doctor will give a detailed assessment of your impairment along with a list of the many tests and treatments used in your condition.

This seemed to be the hardest part so far. My rheumatologist held on to the incomplete report for 8 weeks before Mommy and I camped out in his office and reported him to the Hospital administration. Finally, it took less than 15 minutes for him to complete the required paperwork. Thanks Doc, for all the stress and worry for no reason.

I sent the requested reports (from him and me), copies of all correspondence between my medical team and a cover letter to Centrelink, on Friday. Although I have linked my letter here, I do not know if it will be successful, so if you choose to use parts of it, I cannot guarantee an outcome.

Wish me luck.

[i] These lists come from the U.S. Department of Labour’s Job Accommodation Network. I do not believe that there is an equivalent list in Australia (yet!)

Once again, another blog author has made me have a think. I had to look at a previous post (Zoom! Zoom! Zoom! (Fibro Style)) to realise that I hadn’t quite covered the topic as well as I meant to; and as I sat crying in my Mommy’s car, after a one hour appointment with the rheumatologist, where we both begged for some sort of strategy or plan – not just to be told that this is it… – I felt like all I’m doing is rushing from one appointment to another, from one class to the next.

Yes, I had also been at the acupuncturist earlier in the day, followed by an appointment with the optometrist, where he flashed harsh lights into my eyes and then expected me to be able to read the stupid board! And yes, I was feeling a touch fragile; but this feeling was overwhelming – it’s all too much!

It shouldn’t be TOO much. I want to be able to go back to work. I want to run 100 files. I want to research. I want to have back-to back appointments. But, if I can’t handle a handful of classes in a week, how am I ever going to be able to return? And should I even want to put myself under so much stress?

Anyway, although I didn’t really feel like it at the time, the next day I went to my Tai Chi class. Concentrating on moving my hands, my feet and my breath does amazing things for clearing one’s mind.

The next week’s that is coming looks to be another busy one – can’t really put off some of the things that aren’t FM related. Life still goes on, right?

But, I gotta tell you, if I get anymore shit from Centrelink, I will probably lose it!

This is a Word Cloud from Wordle. I discovered it by visiting Falling Out of the Fog. Wordle is a toy for generating word clouds from text that you provide. The clouds give greater prominence to words that appear more frequently in the source text. In this case, I put my blog through the toy.

It appears that I am great propounder of RELAXATION (although fibromyalgia is not that far behind). But do I practise what I preach?

Today was Tai Chi day – a relaxing hour of moving meditation. Then it was off to a new gym with my Mommy to find out about Body Balance classes – a holistic fitness program combining yoga, tai chi and Pilates. Mommy and I are going to try to go twice a week – and this is from a woman who doesn’t exercise. Although I think I can remember some Jane Fonda Beta videos back in the early 80s.

And now, here is where some relaxation techniques may have been useful…

On the way home, I called my rheumatologist, who has still not returned a finished medical report for my disability claim, for my weekly nag and reminder about this! (Don’t you think 8 weeks is long enough to fill in a form?)

Then, I received a phone call from Centrelink – supposedly I was no longer eligible for Sickness Allowance. What the HELL? Allegedly (oh, look! I’m still a lawyer!), information received from my employer made me no longer eligible. Supposedly I didn’t have a job to go back to – WHAT! I have an office there! I have 10 certificates framed and hanging on the wall there! I have business cards printed with that address! And, more importantly, I had spoken to my boss last week and everything was still okay. Anyway, the lady I was speaking to wasn’t permitted to give me any specific information about what had been said but she put me through (after a 20 minute hold time) to apply for a job seekers (incapacitated) payment application. This process was going to take at least 2 weeks – that’s 2 weeks without ANY money!

I made the appointment then got on the phone to my boss. After a quick discussion, I drafted a fax for him to sign and send to the original lady so that, hopefully, my eligibility will be reviewed and I can get paid. Quick(-ish) phone call back to that lady to make sure she knew that this (really important!) fax was coming through to her; then sit back and take a breath.

But NO! A phone call from my semi sister-in-law (my brother and her are living in sin!) about writing a legal-sounding letter to the supermarket, where two runaway trolleys had taken out the back of her car.

Then, some internet research about making an objection about misleading and deceptive conduct by Metricon (a building company in Australia) who, in my opinion (and the Australian Competition and Consumer Commission agree!), are trying to charge my brother an extra $10 000.00, for something that was supposed to be included.

Finished? Not yet…Another phone call – this time to my medical insurance company. It should have been easy – all I wanted was to know how much money I would receive after ordering my contact lenses. Obviously, not such an easy question.

Big sigh! Gotta say that letting all that out is a great relaxation technique! I feel so much better!

The day started with a doctor’s appointment to get a new medical certificate for Centrelink (yes! I’m still on Sickness Allowance and not Disability). I remember my list of things to tell the doctor – and, FINALLY, I remembered to take my postcards.

I left 10 in the reception area.

The pharmacist is now Fibromyalgia Aware!

The off to the Chemist to fill my prescriptions. Guess what I left there?

And then it was off to get acupuncture! (insert YIPPEE!) Being slightly early, and incredibly organised (for once), I stopped in at the printer next door and had some posters printed into A3 size.

Paul (the acupuncture dude) in reception with his postcards

Now back to get acupuncture, and feeling very pleased with myself. Paul, my acupuncturist, allowed me to leave some postcards in a prominent position.

My campaigning continued as I skipped merrily on my way home.

At the party suppies store...

At the Op shop

At the chiropractor's office...

So, now I am feeling incredible smug (and tired!) as I turn East Bentleigh PURPLE!

P.S. You may have noticed my badge on my profile picture. You can get one (I can’t work out how to make it a widget) HERE!